Practice 10-Minute Consultation

Anabolic steroid use

BMJ 2016; 355 doi: http://dx.doi.org/10.1136/bmj.i5023 (Published 13 October 2016) Cite this as: BMJ 2016;355:i5023
  1. John H M Brooks, academic foundation year 2 doctor1,
  2. Imtiaz Ahmad, general practitioner and trainer, and sports medicine physician2,
  3. Graham Easton, general practitioner and programme director3
  1. 1Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
  2. 2South Lambeth Road Practice, London SW8 1UL, and Guy’s and St Thomas’ Hospital, London SE1 7EH
  3. 3Imperial GP Specialty Training, Department of Primary Care and Public Health, Imperial College London, London, W6 8RP
  1. Correspondence to: J Brooks JohnBrooks{at}doctors.org.uk

What you need to know

  • Ask about anabolic steroid use in a non-judgemental way, strongly encourage cessation, and explain the side effects and long term health risks

  • Male patients (<2% female) may present with local infection at injecting sites or stress related mood changes

  • Initially, offer annual monitoring for cardiac (electrocardiogram and echocardiogram) and hepatic (liver function tests) complications

A 27 year old man weight-trains five times a week and has used anabolic steroids orally for six months. He is concerned about long term health consequences.

Anabolic steroids are synthetic testosterone derivatives usually taken without medical advice to increase muscle mass or improve athletic performance. Risk factors include male sex (<2% female),1 body dysmorphic disorder,2 competitive sport participants, and bodybuilders. Steroid induced muscle gain is possible even without training.4 There are an estimated three million users in Europe.5

What you should cover

Establish the substances involved and pattern of use. Testosterone derivatives are known as “roids” or “juice”. Some nutritional supplements may also contain steroids.7

Ask about duration and pattern of use, including “cycling” of different combinations of drugs over 6-12 weeks, “stacking” of more than one different steroid, and “pyramiding” by using variable doses to improve effectiveness and reduce side effects. Users may periodically abstain to allow normal hormonal production to return (“post-cycle therapy”) to try and prevent hypothalamic-pituitary-gonadal …

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